COMTREAs School Based Health Centers DR. NATHAN SUTER, DDS O R A L - PowerPoint PPT Presentation

COMTREA’s School Based Health Centers DR. NATHAN SUTER, DDS O R A L H E A L T H D I R E C T O R & D E N T I S T C O M T R E A C O M P R E H E N S I V E H E A L T H C E N T E R 4 3 0 0 G R A V O I S R D H O U S E S P R I N G S , M O 6 3 0 5 1 N S U T E R @ C O M T R E A . O R G C E L L : 3 1 4 - 5 9 4 - 7 1 7 0

Common characteristics of SBHCs  Located in schools or on school grounds.  Work cooperatively within the school to become an integral part of the school.  Provide a comprehensive range of services that meet the specific physical, dental, and behavioral health needs of the young people in the community.  Employ a multidisciplinary team of providers to care for the students: nurse practitioners, registered nurses, physician assistants, social workers, physicians, alcohol and drug counselors, dentists, dental hygienists, and other health professionals.  Provide clinical services through a qualified health provider such as a hospital, health department, federally qualified health center, or medical practice.  Require parents to sign written consents for their children to receive the full scope of services provided at the SBHC.

Types of SBHCs  Service Delivery Types  Primary Care  Portable  Chronic Conditions  Mobile  OBGYN  Fixed  Pediatrics  Telehealth  Dental Care  Hybrid  Preventive  Provider Groups  Full Service  Private for profit  Behavioral Health  FQHC  Counseling  Local Health Dept.  Psychiatry  Hospital  Substance Abuse  University Partnership  CSTAR

COMTREA Comprehensive Health Center  Community Mental Health  Tooth Fairy Center since 1974  PSP in all schools  Federally Qualified Health  Valley Clinic Center (FQHC) since 2012  Fixed Clinic – 3 chairs  First School Based Health  Comprehensive Care Center opened in 2013  Adults and Children  School Based Oral Health  Fox Clinic  Screenings  Fixed Clinic – 5 chairs  Mobile / Portable Prevention  Comprehensive Care  Follow up Comprehensive care  Adults and Children  Tooth Titan  Mobile/ Portable Hybrid  Prevention and Exams  Limited Restorative  Children Only

Valley SBHC Clinical Services  Counseling Services  Providers and Staff  2 Dentists  Monday and Tuesday  1 Child Psychiatrist  7:30 -3:00  1 APN Child Psych  Wednesday  3 Counselors  7:30-6:00  1 Case manager  Thursday  2 Hygienists  7:30-5:00  3 Dental Assistants  Fridays  3 Secretaries  7:30-3:00  Dental Services  Psychiatric Services  Monday-Friday  8:00-6:00  Wednesdays  Primary Care  7:30-3:00  Coming fall 2016  CSTAR Substance Abuse Services  Monday-Friday  9:00-5:30

Supporting NWR1 Graduates: COMTREA’s Team Members  Lauren Willis  Nicole Bollinger  Dental Assistant  Dental Operations Manager  Class of 2013  Class of 2004

Northwest R-1 District Statistics  6,700 Students Northwest R-1 District 2014-2015 PSP Population Data 100%  2,597 Students F&R 90% 80% Lunch 70%  38.76% Free and Reduced 60% 50%  914 students screened 40% 30% State Untreated Decay Average 24%  35% had untreated tooth 20% 10% decay 0%  State average 24%  82% have no dental sealant Percent Untreated Decay Percent with No Sealant

Fox Service Center / Early Childhood Center  Providers and Staff  2 Dentists  2 Hygienists  3 Dental Assistants  2 Secretaries  Dental Services  Monday-Friday  8:00-6:00  Behavioral Health Coming soon… 

Supporting Fox Graduates: COMTREA’s Team Members Nathan Suter, DDS Renee Blanken, RDH Ashley Wegener, RDH Toni Rushing, DA

Missouri Foundation for Health COHI Project  New School Based  $300,000 MFH Grant Health Center for Equipment  Largest School District in  $400,000 COMTREA Jefferson County Match for Construction  Covers 1/3 of the Jefferson  Estimated 2,000 patient County visits a year projected  Highest Number of Free and Reduced Lunch Participants

Fox C-6 District Statistics  11,679 Students Fox C-6 District 2014-2015 Population PSP Data  3657 Students F&R 100% 90% Lunch 80% 70%  31.31% Free and Reduced 60%  1363 students screened 50% 40%  31% had untreated tooth 30% State Untreated Decay Average 24% 20% decay 10% 0%  State average 24%  82% have no dental sealant Percentage Untreated Decay Percentage with No Sealants

School Based Health Center: Hub & Spoke Model Those with needs get • On-Site Diagnosis • identified. Cedar & Prevention Springs Those with only • Tooth Titans • cleanings and High Ridge Murphy By Dentist & • checkups stay at Hygienist school. Valley Brennan Maple Clinic Woods Grove Students restorative • needs are referred Needed Resource for to the SBHC Clinics • Woodridge Early Child the Community Students with • NW High Innovative Model: complicated needs • 1 st like it in Missouri are referred to a Main Clinic.

Dental Outreach and Care Coordination Workflow PSP Screenings Free Dental Screenings performed at all but 3 Jefferson County school districts Urgent Early Low Refer Recalls Needs Needs Needs out Private Tooth Titan Fixed Clinic Mobile Van Valley, Fox, or Office Hillsboro

Tooth Titans Mobile Dental Van Single Operatory Mobile /Portable Clinic: Prevention, Diagnostics, and limited treatment.

Able to transport portable equipment to set up inside of a school.

Also able to treat inside the vehicle.

Care Coordination  School Dental Health  Moving away from Coordinator appointment based scheduling  Part Time School District Employee  Coordinating different  Nurses Room Aid systems of care  COMTREA provides a  Mobile vehicle  Telehealth  Desk inside COMTREA office  Portable  Coordinates appointments  Fixed Clinic  Finalizes paperwork and  Hospital consent forms with parent  Managing a population’s  Communicates with school care and not waiting for the district staff patient to show up.  Transports students from surrounding school buildings

Funding Sources  Grants Valley SBHC Dental Payor Mix Medicaid % Uninsured % Comm Insurance %  Missouri Foundation for 4% Health 11%  HRSA – Primary Care Expansion  Fee-for-service 85%  Sliding fee COMTREA SBHCs‘ Dental Visits by Clinic  Medicaid 300 250  FQHC enhanced 200 reimbursement. 150 100  Provides sustainability 50 0 Nov 2015 Dec 2015 Jan 2016 Feb 2016 Valley Fox

Challenges and Lessons Learned Kids like to knock their teeth out.  Nurses are the  CE for tooth trauma  Gatekeeper!! Build on each year  Integrate into the community as a   Creative ways to get resource. Hub & Spoke Model enrollment in SBHC  Outreach  Program. Education  Mobile   Factor in Snow Days Fixed Clinic  Care Coordination   Simplify Paperwork  School District Buy-In  Make or Break  Increase Access when school is out.

Keys to Replication  Needs assessment of schools  MO DHSS PSP Program  Grant writing to invest in initial capital for startup.  Community Stakeholder buy-in.  School Board and Superintendent are KEY!!!  Happy Nurses make for a good SBHC.  A robust effort to enroll students in the SBHC  Screenings, educational events, open houses, sporting events, kindergarten registration, school enrollment packets.  Flexible Staff and Providers that want to work in a unique setting.  School nurses are looking for dental solutions for the students. They will pick a program like this over the corporate “ prophy mills” the majority of the time.